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Information ⬇

Editors

AnneliKivijärvi

Postcoital Contraception

Essentials

  • A copper IUD is the most effective postcoital contraception method. It can be inserted within 5-6 days after the intercourse.
  • The effect of hormonal postcoital contraceptive pills is best if taken within 12 hours after unprotected intercourse. Depending on the country, they may be available in the pharmacy as over-the-counter products without age limit.

Hormonal contraception Levonorgestrel Combined with Ethinyloestradiol for Postcoital Contraception, Interventions for Emergency Contraception, Copper Intrauterine Device for Emergency Contraception

Levonorgestrel

  • Effective Interventions for Emergency Contraception, and more effective than the Yuzpe regimen using combination oral contraceptive pills.
    • The Yuzpe regimen has largely been abandoned.
  • Levonorgestrel 1.5 mg is taken as soon as possible, at the latest 72 hours after intercouse. If taken later, the effect is more unreliable.
  • Pregnancy starts in 1-2.5%.
  • Contraindications
    • No other contraindications than pregnancy
  • Adverse effects
    • Mild nausea

Ulipristal acetate

  • Ulipristal acetate (Ellaone® , 1 tablet) is a synthetic progesterone receptor modulator.
  • Indicated for emergency contraception within 120 hours (5 days) of unprotected sexual intercourse or contraceptive failure.
  • Contraceptive effectiveness is similar to levonorgestrel Interventions for Emergency Contraception when emergency contraception is used 0-72 hours after sexual intercourse. In a trial where emergency contraception was taken 48-120 after intercourse, pregnancy rate was 2.1%, i.e. 61% of the expected pregnancies were prevented.
  • Contraindications
    • No other contraindications than pregnancy
  • Adverse effects
    • Gastrointestinal adverse effects are the commonest.

Postcoital contraception during breastfeeding

  • Lactation is not a contraindication; however, the infant can be protected from the exogenous steroids by skipping one breastfeeding session after levonorgestrel and replacing it with manual or mechanical emptying of the breasts. Lactation is not recomended for one week after ulipristal acetate.

An intrauterine device as postcoital contraception Levonorgestrel Intrauterine Device for Emergency Contraception

  • A copper IUD Copper Intrauterine Device for Emergency Contraception can be inserted up to 5-6 days after unprotected intercourse and be left in place and used for continuous contraception when needed.
  • If there is a suspicion of cervicitis, an IUD may be inserted at discretion, but the samples to detect infections (gonococcal and chlamydial) must be taken in advance, and a course of antimicrobials is prescribed without waiting for the results.

References

Evidence Summaries ⬆